Provider Demographics
NPI:1811345986
Name:HUFSTEDLER, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HUFSTEDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 E AVENUE G
Mailing Address - Street 2:
Mailing Address - City:VALLEY MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76689-4469
Mailing Address - Country:US
Mailing Address - Phone:254-709-0791
Mailing Address - Fax:
Practice Address - Street 1:1007 E AVENUE G
Practice Address - Street 2:
Practice Address - City:VALLEY MILLS
Practice Address - State:TX
Practice Address - Zip Code:76689-4469
Practice Address - Country:US
Practice Address - Phone:254-709-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care